P - 8380553��--203 �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612)642-0800
Home Duplex Apt. Bldg.
Commercial I ustrial Farm
Air Cond. Htg. Equip. Water Htr.
Dryer Range Elec. Heat
"X" above th k covered by this reques►. Enter
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New
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Load Mgmt. Other:
Temp. Service
narks in this space and on ►he back of the white copy only.
Calculate Inspection Fee - This Inspection Request will noi be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR�s use oN�r TOTAL
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi thaf 1 ins ed the electrical installation described herein on ihe dates siafed
Irrigation Boom Ro�gMo Dare
Speciallnspe '�
Imestigative ee � Final . Y.�-.- - p°r�._� -,
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 months (rom validafion date prinfed in fhis box.
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PLEASE PRINT OR TYPE
esf Daf Rou h-in ins ecfion r uired? ❑ Yes
g p eq ❑ No Inspection Other Than Rough-In: dy Now ❑ Will Call
�' � (You must call the inspecror when ready� Date Ready:
I, ' ensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Bo , or Rouie No.) C' � Zip Code
Section No. Township Name or No. Range No. Fi�e No. Coun �
or
■
Address
Phone No. \
iv
License No. Master
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No.
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